Metronidazol 250mg Domesco tablets for parasitic and infections (2 blisters x 10 tablets)

Dosage form Box of 2 blisters x 10 tablets
Specifications Metronidazole

Ingredient

Composition information	Content
Metronidazole	250mg

Uses

indications

Metronidazol 250mg drug is indicated in the following cases:

Trichomonas disease has symptoms:

The drug is indicated to treat T.Vaginalis infection in women and men when the presence of trichomonas has been determined by appropriate tests (glass and/or culture tests).

Asymptomatic trichomonas disease:

The drug is indicated in the treatment of t.vaginalis infections with no symptoms in women associated with cervical endometritis, cervicitis or cervical gland inflammation. Because there is evidence that the presence of Trichomonas can affect the accurate assessment of abnormal glass tests, should perform additional glass tests after killing parasites.

Treatment for subjects with asymptomatic sex:

T. Vaginalis is infected with sex. Therefore, the treatment should be treated at the same time with asymptomatic sex of the patient if the parasite has been identified, to prevent re -infection from the partner. When making this decision, it should be noted that there is evidence that women may be re -infected if the partner is not treated. In all cases, Metronidazol should be treated for a partner in the case of re -infection.

Amoeba disease:

metronidazol is indicated in the treatment of acute bowel amoeba and liver abscess caused by amoeba. In liver abscess due to amoeba or pus suction combined with metronidazol treatment.

Anaerobic bacteria infection:

The drug is indicated in the treatment of serious bacterial infections caused by sensitive anaerobic bacteria. Surgical indications should be combined with metronidazol therapy. In case of aerobic and anaerobic bacteria, Metronidazole should be used with appropriate antibiotics to treat aerobic bacteria infection.

Bacterial infection in the abdomen: Including peritonitis, abdominal abscess and liver abscess, caused by Bacteroides including group B. Fragilis (B. Fragilis, B. Distasonis, B. Ovatus, B. Thetaiotaomicron, B. Vulgatus), Clostridium species, eubacterium species, peptoccus species and peptococcus species and species species and species species and species species and species species and species species and other species species and other species species and other species species and other species species and other species species and other species species and other species species and other species species and other species species and other species species and other species species and other species Peptostreptoccus.

Skin infections and skin structure: caused by bacteroides including B. Fragilis group, clostridium species, peptococcus species, peptostreptococcus species and fusobacterium species.

Gynecological infection: Including endometritis, ovarian abscess and vaginal tape after surgery, caused by Bacteroides including B. Fragilis group, clostridium species, peptococcus species, peptostreptococcus species and fusobacterium species.

Bacterial infections: caused by bacteroides including B. Fragilis and Clostridium species.

Bone and joint infections (such as supportive therapy): caused by Bacteroides species including B. Fragilis.

Central nervous system infection (CNS): Including meningitis and brain abscess, caused by Bacteroides species including B. Fragilis.

Lower respiratory infections: including pneumonia, pleural inflammation and lung abscess, caused by Bacteroides species including B. Fragilis.

endocarditis: caused by Bacteroides species including B. Fragilis.

To reduce the growth of anti -drug bacteria and maintain the effectiveness of metronidazol and other antibacterial drugs, only Metronidazol only used to treat or prevent identified or suspected infections caused by sensitive bacteria.

When there is information on test results and sensitivity, consider selection or adjustment of antibacterial therapy. In the absence of data, selection of experience based on epidemiological characteristics and sensitivity of local bacteria.

Pharmacokic

metronidazol is a 5-nitro-imidazol derivative, with broad-activated spectrum on primeval animals such as amoeba, giardia and in anaerobic bacteria.

The mechanism of action of Metronidazol is not very clear. In parasites, group 5 - nitro of the drug is reduced into toxic mediators to cells. These substances bind to the twisted structure of the DNA molecule that breaks these fibers and eventually causes dead cells.

Metronidazol's effective average concentration is 8 micrograms/ml or lower for most primary animals and sensitive bacteria. Minimum inhibitory concentration (mic) sensitive strains about 0.5 micrograms/ml. A strain of bacteria when isolated is considered to be sensitive to the drug when the mic does not exceed 16 micrograms/ml.

Metronidazol is a very strong drug in the treatment of primeval animal infections such as Entamoeba Histolytica, Giardia Lamblia and Trichomonas Vaginalis. Metronidazol has bactericidal effects on bacteroides, fusobacterium and other mandatory anaerobic bacteria, but does not work on noni bacteria.

Metronidazole is only resistant to a few cases. However, when using Metronidazol alone to treat Campylobacter/ Helicobacter pylori, the drug resistance is quite fast. When infected with both anaerobic and anaerobic bacteria, Metronidazol must be combined with other antibacterial drugs.

Trichomonas vaginalis infection can be treated with oral metronidazole or used on the spot. Both women and men must be treated, because men can carry pathogens without symptoms. In many cases, it is necessary to treat vaginal drugs and tablets.

When bacterial/vaginal inflammation is caused by bacterial/vaginal inflammation, Metronidazol will cause the vaginal bacteria to return to normal in the majority of patients who use drugs: Metronidazol does not affect the normal bacteria in the vagina.

Metronidazol is a standard treatment for prolonged diarrhea and giardia. Metronidazol is the first choice to treat acute dysentery and heavy liver abscess due to amoeba, although the dose is different.

When abdominal infections accompanied by abscess such as appendic abscess, post -intestinal infections and liver abscess, and when gynecological infections such as infected endometritis and abscess need to combine metronidazol with a beta lactam antibiotic, such as a new generation cephalosporin.

Bacteroides Fragilis or Melaninogenicus often cause lung infections leading to abscess after mucus suction procedure, necrotic pneumonia with pulmonary abscess and pleura. At that time, it is necessary to combine Metronidazol or Clindamycin with a beta lactam antibiotic. Brain abscess or tooth infections caused by both anaerobic and anaerobic bacteria are also treated according to the same principle.

Metronidazole works well against bacteroides, so it is often used as a standard medicine to prevent gastric and intestinal surgery. Most of Metronidazol combination standard regimen with a betalactam antibiotic such as a new generation cephalosporin. This principle prevents good abscess complications after appendicitis.

metronidazol (not vancomycin) is selected in diarrhea due to Clostridium difficile. In this case, Vancomycin should not be used because it is easy to cause Vancomycin resistance, which is very harmful when it is necessary to use Vancomycin.

Metronidazol strains have been shown to contain low ferredoxin; This substance is a metronidazol reduction catalyst protein in those strains. Ferredoxine decreases but not completely lost, perhaps explaining why infections with those strains respond to higher metronidazol doses and longer.

Dynamic pharmacokinetics

Metronidazole often absorbs quickly and completely after drinking, reaching a plasma concentration of about 10 micrograms/ml about 1 hour after drinking 500 mg. Linear correlation between dose and plasma concentration takes place within the dose range from 200 - 2,000 mg.

Dosage repeated every 6 - 8 hours will cause the cure to accumulate. Metronidazol's waste sale time in plasma is about 8 hours and the distribution of approximately water volume in the body (0.6 - 0.8 liters/kg). About 10 - 20 % of the drug is linked to plasma proteins.

Metronidazole penetrates well into tissues and fluids, saliva and breast milk. The concentration of treatment is also achieved in cerebrospinal fluid.

metronidazole metabolizes the liver into hydroxy and acid metabolic substances, excreted in urine partially in the form of glucuronid. The metabolites still have some pharmacological effects.

Average half -life in plasma is about 7 hours. The sale time of hydroxy metabolites is 9.5 - 19.2 hours in patients with normal kidney function. Over 90 %of oral doses are eliminated through the kidneys for 24 hours, mainly hydroxy metabolites (30 - 40 %) and acid form (10 - 22 %). Less than 10 % excreted in the form of status quo. About 14 % of the dosage dosage.

In patients with renal failure, the semi -disposal time of Metronidazol does not change, but the sale time of hydroxy metabolites lasts 4-17 times. Metronidazol metabolism may be affected when suffering from severe liver failure. Metronidazole can be eliminated from the body effectively with blood decomposition.

Before taking Metronidazol 250mg Domesco tablets for parasitic and infections (2 blisters x 10 tablets)

How to use

oral medication.

Dosage

Trichomonas disease:

In women:

1 -day treatment regimen: 2 g, use only once or divide 2 times, each time 1 g, used in the same day.

7 -day treatment regimen: 250 mg x3/day, for 7 consecutive days.

From controlled comparative studies are determined by vaginal cell spread, signs and symptoms, the 7 -day 7 -day treatment regimen has a higher cure rate than a 1 -day treatment regimen.

Dosage should be adjusted depending on the patient. Single dose treatment can ensure adhesion in patients who cannot continue the 7 -day treatment regimen, especially if used under supervision. The 7 -day treatment regimen reduces the patient for a long time when there is a sexual intercourse. In addition, some patients can tolerate this treatment regimen better than the other treatment regimen.

Pregnant patients should not be used in the first 3 months of pregnancy. In pregnant patients, do not respond to alternative therapy, should not be treated with a 1 -day regimen, because of the higher serum metronidazol level, may be at the fetal circulation.

When the dose is needed, after 4-6 weeks between treatments, the presence of trichomonas should be redefined by appropriate tests. Check the number and type of leukocyte before and after repeat treatment.

In men: Treatment depends on each patient similar to women's treatment.

AMIP:

Adults:

For acute intestinal amoeba: 750 mg x 3 times/day, for 5-10 days.

For amoeba liver abscess: 500 mg or 750 mg x 3 times/day, for 5-10 days.

Children: 35 - 50 mg/kg/24 hours, divided into 3 times, taken for 10 days.

Anaerobic bacteria infection:

In the treatment of the most serious anaerobic bacteria, Metronidazole is often used in intravenously.

The usual dosage in adults is 7.5 mg/kg every 6 hours (about 500 mg for adults 70 kg).

Maximum must not exceed 4 g in 24 hours.

normal treatment time is 7-10 days; However, bone and joint infections, lower respiratory tract and endocarditis may need longer treatment.

Dosage adjustment:

Patients with severe liver failure: 50 % reduction of dose.

Patients with hemolysis:

Hemolysis removes a significant amount of metronidazol and its metabolites from the circulatory system. The clearance of metronidazol depends on the type of filter used, the time of hemolysis and other factors. If it is necessary to use Metronidazole when hemolysis, it is recommended to supplement the metronidazol doses after hemolysis, depending on the patient's clinical condition.

Note: The above dose is for reference only. Specific dosage depends on the condition and level of progression of the disease. For a suitable dose, you need to consult a doctor or medical specialist.

What to do when overdose?

Symptoms and manifestations when using overdose drugs:

Metronidazol takes a single dose of up to 15 g has been reported. Symptoms include nausea, vomiting and loss of air conditioning. The nerve effect of convulsions, peripheral neural inflammation has been reported after 5-7 days of use 6 - 10.4 g 2 days/time.

How to deal with overdose drugs:

Treatment: There is no specific antidote. Symptomatic treatment and support. Actively monitor for timely measures.

What to do when you forget 1 dose?

Drink as soon as you remember. If the time is close to the next medication, skip the forgotten dose and take the next dose at the usual time. Do not use double dose to compensate for the forgotten dose.

Side Effects

When using the drug, you may experience unwanted effects (ADR).

Agencies

Frequency (*)

Unwanted reactions All bloody platforms.

Metabolic and nutrition disorders unknown anorexia. frustration. can be solved by stopping the drug.

Sleep, dizziness, convulsions, headaches.

unknown during intensive and long -lasting metronidazol treatment, peripheral neuropathy or a transient epilepsy convulsions have been reported. In most cases, neuropathy disappears after stopping treatment or when the dose is reduced.

Aseptic meningitis.

and unknown internal ears

hearing impairment/hearing loss (including reception nerves), tinnitus. flow.

In case of liver failure, liver transplant has been reported in patients treated with metronidazol in combination with other antibiotics.

Skin disorders and subcutaneous tissues Dinh. Metronidazol). clear (not estimated from available data).

Instructions on how to handle ADR

When experiencing side effects of the drug, it is necessary to stop using and notify the doctor or go to the nearest medical facility for timely treatment.

Warnings

Before using the drug you need to read the instructions carefully and refer to the information below.

Contraindicated

contraindicated drugs in the following cases:

Hypersensitivity to hypersensitivity to metronidazol, other nitro - imidazol derivatives or any ingredients of the drug.

Metronidazol is contraindicated for use in the first 3 months of pregnancy.

Caution when using

Clinical and clinical monitoring recommendations (especially white blood cells) if using Metronidazol for more than 10 days and need to monitor adverse reactions such as peripheral or central neuropathy (such as abnormalities, loss of air conditioning, dizziness, convulsions).

Be cautious when using Metronidazol in patients with severe central and peripheral neuropathy due to the risk of worse than menstrual diseases.

Cases of severe liver toxicity/acute liver failure, including deaths with very fast onset after the start of treatment in patients with cockayne syndrome has been reported with products containing metronidazol used the whole body.

In this case, Metronidazol should only be used after careful assessment of benefits - risks and there is no alternative treatment. Liver function tests must be performed immediately before the beginning of treatment, during treatment and after the end of treatment until the liver function is within normal range or until the initial values are achieved. Should stop the drug if the liver function tests are significantly increasing during treatment.

Patients with cockayne syndrome should immediately report any symptoms of the hidden liver damage to the doctor and stop using Metronidazol.

Cases of serious malignant skin reactions such as Stevens -Johnson syndrome (SJS), poisoned epidermal necrosis (Ten) or acute all -body pustular syndrome (AGEP) have been reported to Metronidazol. If there are symptoms or signs of SJS, Ten or Agep, it is necessary to stop using Metronidazol immediately.

After Trichomonas Vaginalis has been removed, gonorrhea is still likely to exist.

Metronidazol's waste time does not change when renal failure. Therefore, there is no need to reduce the dose of metronidazol. However, the metabolites of Metronidazol are retained in these patients. So far, unclear clinical significance of this.

In patients with hemolysis, Metronidazol and metabolites are effectively removed during 8 hours of fertilizer. Therefore, the dose should be repeated with metronidazol immediately after hemolysis.

No need to adjust the dose in patients with diagnosis of the peritoneal interruption (IDP) or peritoneal cessation of outpatient peritoneal (CAPD).

metronidazol is metabolized mainly by the oxidation of the liver. Metronidazole clearance may be significantly impaired when the liver failure progresses. A significant accumulation can occur in patients with liver and high concentration in plasma of Metronidazol, which can contribute to the symptoms of brain disease. Therefore, Metronidazole should be used to be cautious for patients with liver breeding. Daily dose should be reduced to 1/3 and can be used 1 time/day.

Patients should be warned that Metronidazol can darken urine.

Due to insufficient evidence of the risk of mutations in humans, the use of metronidazol for long -term treatment is often carefully considered.

The drug contains starch, humans allergic to flour (except for coeliac) should not use this drug.

Patients with galactose tolerance problems, patients with lapp lactase deficiencies or glucose - galactose should not be used.

The ability to drive and operate machinery

The drug can cause drowsiness, dizziness, confusion, hallucinations, convulsions or mild visual disorders. Patients should not drive or operate machinery if these symptoms occur.

Pregnancy

Metronidazole through the placenta is quite fast, achieving the concentration rate between the stem of the placenta and the mother's plasma is approximately 1. Although thousands of pregnant women have used drugs, there has been no notice of teratogenicity.

However, there are also a number of studies that have announced the risk of increased monsters when taking the drug in the first 3 months of pregnancy. Therefore, it is not advisable to use during the first time when pregnant, unless required.

The period of breastfeeding

metronidazol excreted in breast milk quite quickly, breastfed babies may have plasma medication levels equal to about 15 % of the mother concentration. Metronidazol should be stopped when treated with Metronidazol.

Interactive drug

Interactive drugs:

Patients should not drink alcohol during Metronidazol treatment and at least 48 hours later because of the ability to have a disulfiram effect. Psychosis has been reported in patients using Metronidazol and Disulfiram simultaneously.

Metronidazole increases the anticoagulant effect of Warfarin oral anticoagulants. Reduce the dose for the next use. Prothrombin should be monitored. There is no interaction with heparin.

Lithi accumulates with evidence of kidney damage that have been reported in patients treated simultaneously lithium and metronidazol. Lithit dosage should be reduced gradually or stop using lithit when using metronidazol. Lithi concentration in plasma, creatinine and electrolytes should be monitored in patients treated with lithium while taking Metronidazol.

Patients with phenobarbital or phenytoin, metronidazole metabolism is much higher than normal, the selling time is reduced to about 3 hours.

metronidazole reduces the clearance of 5 - fluorouracil and thus can increase the toxicity of 5 - fluorouracil.

Patients with simultaneous use of ciclosporin and metronidazole are at risk of increasing serum ciclosporin levels. Ciclosporin closely monitoring should be monitored in serum and serum creatinine when used simultaneously.

Busulfan concentration in plasma can be increased by Metronidazol, which can lead to severe busulfan poisoning.

The cavalry of the drug:

Do not have studies on oral medications, do not mix this drug with other drugs.

Storage

Store in: dry place, temperature below 30 ° C, avoid light.

Storage in the original packaging of the drug.

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